Healthcare Provider Details

I. General information

NPI: 1720028913
Provider Name (Legal Business Name): JAMES EDWARD SHADBOLT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PUMP RD STE 227
HENRICO VA
23233
US

IV. Provider business mailing address

110 N ROBINSON ST SUITE 100
RICHMOND VA
23220-4459
US

V. Phone/Fax

Practice location:
  • Phone: 804-754-7400
  • Fax: 804-754-7402
Mailing address:
  • Phone: 804-359-0569
  • Fax: 804-359-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000832
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: